Abstract

Aim. To assess the level of pro-adrenomedullin in patients with chronic forms of coronary heart disease and to identify possible relationship with the indicators of left ventricular systolic function.

Methods. 110 patients with ischemic heart disease and myocardial infarction with preserved left ventricular ejection fraction [average age 54.9 (42; 64) years] and 130 patients with ischemic cardiomyopathy [average age 55.2 (42; 64) years] were observed. All patients underwent transthoracic echocardiography by a standard technique and pulsed-wave tissue Doppler, left ventricular ejection fraction and myocardial performance index (Tei index) were calculated, maximum systolic velocity of the lateral part of the fibrous ring of the mitral valve was estimated. Pro-adrenomedullin level was measured in serum.

Results. In both groups the level of pro-adrenomedullin was statistically significantly higher than the control va­lues — 0.49 (0.18; 0.58] nmol/L (p <0.017 and p <0.001, respectively). At the same time, in the group of patients with ischemic cardiomyopathy, the level of pro-adrenomedullin was statistically significantly higher than in the group of patients with ischemic heart disease and myocardial infarction with preserved left ventricular ejection fraction [1.72 (1.56; 1.98) nmol/l and 0.89 (0.51; 1.35) nmol/l, p <0.001]. Correlation analysis in both groups revealed statistically significant associations of the pro-adrenomedullin level with the left ventricular ejection fraction (r=–0.45, p=0.039, r=–0.51, p=0.034), maximum longitudinal velocity of the left ventricle (r=0.50, p=0.027, r=0.59, p=0.019), Tei-index (r=0.50, p=0.027, r=0.59, p=0.019).

Conclusion. The data obtained demonstrate the potential of determining the level of pro-adrenomedullin as a biochemical marker of left ventricular dysfunction.

Abstract

Aim. To study the prevalence of various C807T polymorphism variants of the ITGA2 gene and to analyze the association of this polymorphism with platelet aggregation activity in hypertensive patients.

Methods. 47 patients with arterial hypertension treated at the Clinical Cardiology Dispensary (Perm) were included in the study. Genotyping of C807T polymorphism (rs 1126643) was carried out by the method of polymerase chain reaction with the subsequent identification of the single nucleotide polymorphic variant of ITGA2 gene by the method of allele-specific polymerase chain reaction. Platelet aggregation activity was investigated by the impedance method using TRAP-6 reagent as an inducer of aggregation.

Results. The prevalence of C/C, C/T, T/T genotypes of ITGA2 gene among hypertensive patients was 18 (38.3%), 23 (48.9%) and 6 (12.8%), respectively. A comparative analysis of platelet aggregation activity with TRAP-6 reagent revealed statistically significant differences between the groups of patients carrying different genotypes [103.5 (67.0; 121.0) AU in homozygotes –807CC versus 52.5 (48; 83) AU in homozygotes –807TT, p=0.045]. In the group of patients with reduced platelet aggregation activity (TRAP-test less than 94 AU), the carriage of the unfavorable T allele prevailed in comparison with the group of patients with its normal level (OR=3.81, 95% CI 1.38–10.54; p=0.008). In patients of this group, there was a significant increase in the frequency of occurrence of heterozygotes –807CT (OR=4.75, 95% CI 1.24–18.19; p=0.009), as well as an increase in the frequency of occurrence of homozygotes for the variant allele -807TT (OR=2.88, 95% CI 0.31–27.07; p=0.009) compared with the group of patients with a normal level of aggregation.

Conclusion. The prevalence of C/C, C/T, T/T genotypes of ITGA2 gene among patients with arterial hypertension is comparable to the data of European researchers: carriers of T allele of ITGA2 gene may have a higher risk of developing cardiovascular events; the molecular mechanism of the relationship of reduced platelet aggregation activity and carriage of the unfavorable T allele of ITGA2 gene requires further studies.

Abstract

Aim. Study of the features of endovascular intervention, correction of the lipid and carbohydrate metabolism as well as the role of myocardial visualization methods and their effect on delayed results of treatment of patients with left ventricular dysfunctional myocardium and concomitant diabetes mellitus.

Methods. The analysis of the treatment results of patients with dysfunctional myocardium and concomitant diabetes mellitus type 2 was performed. The analysis included 112 patients. The comparison group included 102 patients without diabetes. Visualization of postinfarction myocardial changes was performed with the use of magnetic resinance imaging of the heart both before and after the assessment of the delayed results.

Results. After 18-months follow-up mortality from cardiovascular comlications as well as the rate of major cardiac events was similar to that among patients without diabetes (1.8 and 1%; 6.25 and 3.92%, respectively). The similar tendency was observed 24 months after the intervention (3.3 and 2.3%; 9.8 and 5.7%, respectively). Among the factors associated with the development of such complications are preoperative values of glycosylated hemoglobin ≥6.5%, fasting plasm level of glucose ≥6.0 mmol/l, total cholesterol ≥5.2%, triglycerides ≥1,7 mmol/l, low-density lipoproteins ≥2.5 mmol/l. Also percutaneous coronary intervention later than 30 days after the myocardial infarction and incomplete myocardial revascularization, SYNTAX score >25, transmurality index ≥0.45, cardiac fibrosis ≥45% and presence of diabetes mellitus were prognostically unfavorable risk factors of cardiovascular events.

Conclusion. In patients with left ventricular dysfunctional myocardium and concomitant diabetes mellitus higher efficacy of endivascular intervention was observed and the prevalence of major cardiac events was camparable to the patients without diabetes; delayed percutaneous coronary intervention, incomplete myocardial revascularization, high indices of transmurality and cardiac fibrosis are prognostically unfavorable risk factors of cardiovascular events.

Abstract

Aim. To identify changes of microcirculatory parameters in former hypertensive smokers.

Methods. Videobiomicroscopy was used to study the microcirculation of bulbar conjunctiva in 94 patients suffering from arterial hypertension. The results of former smokers (n=21, average age 41.6±2.5 years) were compared to those of smokers (n=32, average age 36.8±2.2 years) and non-smokers (n=41, average age 40.5±2.3 years).

Results. The average diameter of arterioles, the arteriolar-to-venular ratio and the average diameter of the capillaries were minimal in the group of smokers with hypertension. In former smokers, these indicators increased significantly (p1 <0.0001 for arterioles and arteriolar-to-venular ratio, p1=0.0007 for capillaries) and did not differ from the parameters of those who never smoked (p2=0.8613 for arterioles, p2=0.6817 for arteriolar-to-venular ratio, p2=0.9626 for capillaries). The minimum number of capillaries per 1 mm2 of the conjunctival surface was found in smokers; in former smokers this indicator was significantly higher (p1 <0.0001) and did not differ from non-smokers (p2=0.4301).

Conclusion. The identified positive signs of smoking cessation at the level of microcirculation in the form of an increased average diameter of arterioles and capillaries, increased arteriolar-to-venular ratio and regression of capillary depletion in arterial hypertension allow recommending smoking cessation as an effective therapeutic measure for high blood pressure and endothelium dysfunction caused by smoking.

Abstract

Aim. To study the characteristics of the etiology and clinical picture of acute deep vein thrombosis in children of different age groups.

Methods. The article analyzes the diagnosis and treatment of 77 children and adolescents with acute deep vein thrombosis. The features of the history of patients, previous fact of deep venous catheterization were studied. The fact of the presence and absence of clinical symptoms of thrombosis is registered. The results of ultrasound diagnostics are used. All patients underwent a course of anticoagulant therapy. The results of diagnosis and treatment were evaluated taking into account the age of the patients, the presence/absence of the history of catheterization of deep veins.

Results. When comparing different age groups, their distinctive characteristics were revealed: predominant presence of asymptomatic catheter-associated thrombosis in the younger age group (newborns and infants) with symptomatic deep vein thrombosis of various origin in older children. Among the surveyed, the majority (75.3%) had asymptomatic thrombosis. Pain (2.6%), edema (3.9%) and a combination of pain and edema (18.2%) were more common among symptomatic patients with the symptoms of acute vein thrombosis. In some cases, a combination of two or more complaints was noted. Asymptomatic thrombosis in the catheter-associated thrombosis group amounted to 96.6%. All patients below 1 year had a predisposing factor in the history: 95% - preceding vein catheterization, 5% - postoperative period. With a history of venous catheterization, symptoms of thrombosis were detected 9.2 times less frequently than in children without vein catheterization. In the group of children older than a year, the ratio of thrombosis without a predisposing factor was 10.5%, and the ratio of children with symptoms of thrombosis was 1.38 times higher than among children younger than a year. The only fatal outcome: a 17-year-old patient with a history of thrombophilia, thrombosis of the left iliac vein, pulmonary embolism.

Conclusion. Deep vein thrombosis in children of the first year of life in all cases was caused by a predisposing factor: in children during the first year of life in 95% of cases deep vein thrombosis was asymptomatic and was revealed by ultrasound examination.

Abstract

Aim. To study the impact of the aesthetic component of dental health on the quality of life of young patients.

Methods. 83 subjects with violation of the aesthetics of hard tissues of the anterior group of teeth were examined and treated. Assessment of stability of composite restorations with materials of Russian and foreign production was carried out according to Ryge criteria. A brief questionnaire (the world health organization quality of life WHOQOL-BREF) was used to assess the quality of life.

Results. With the material Filtek Z550 violation of surface preservation occurred in 6 (15.8%) out of 38 men and only 1 (2.2%) out of 45 women (p=0.026). With Estelux NK material the violation of the seal surface preservation occurred in 5 (13.2%) out of 38 men and 2 (4.4%) out of 45 women, the findings are not statistically significant (p=0.15). The total index of quality of life in men and women significantly improved 6 months after the restoration and amounted to 88.7±5.4 points (p=0.024) and 88.4±7.3 (p=0.034), respectively, compared to test results prior to treatment. Stability of the quality of the restoration according to Ryge criteria of both photocomposite materials (Estelux NK and Filtek Z550) had no significant differences, therefore, the domestic material Estelux NK, taking into account its financial availability, can be recommended for aesthetic dental rehabilitation of young patients.

Conclusion. Restoration of the aesthetic optimum of men and women of young age leads to a subjective improvement of psychological comfort and objective increase of self-perception indices.

Abstract

Myodynamic balance of the muscles of maxillofacial area provides required conditions for normal development of dentoalveolar system. Dysfunction of the muscles of facial and oral area is a significant ethiopathogenetic factor of development of anomalies of tooth position and development of upper and lower jaws. Among such factors the most prevalent habits are sucking fingers, mouth breathing (in genetically, anatomically and physiologically caused absence of nasal breathing), incorrect lip seal and infantile swallowing. Position of the tongue in mouth breathing is of particular importance as positioning the tongue between the dental arches causes significant vestibular inclination of the upper incisors. As a result of these changes disocclusion is formed in vertical plane. Additional pressure of stretched buccal muscles during mouth breathing causes narrowing of the dental arches. It is required to mention that many researchers pay attention to decreased bioelectrical activity of masseters in electromyographic study in patients with occlusion anomalies. Formation of this pathology influences not only the general health state (disorder of nasal breathing, swallowing, chewing, sound pronouncing and posture) but also social adaptation of a child. Due to this children require complex approach to the diagnosis and correction of myofanctional disorders of maxillofacial area.

Abstract

Aim. To assess the short-term and long-term variability of blood pressure in women, starting from early pregnancy, to predict the development of complications of gestation, including preeclempsia.

Methods. In 131 pregnant women, systolic blood pressure, diastolic blood pressure, as well as short-term (intra-visit) and long-term (inter-visit) blood pressure variability were assessed during the gestation period and 6 weeks after delivery. At the end of gestation period, depending on the identified complications, all study participants were divided into four groups: group 1 - control (healthy); group 2 - pregnant with preeclempsia; group 3 - with placental insufficiency; group 4 - with chronic arterial hypertension. In patients with placental insufficiency the indices of fetal growth retardation were also analyzed.

Results. In group 4, starting from the second trimester, higher values of short-term blood pressure variability were demonstrated, which increased as pregnancy progressed. Long-term blood pressure variability increased in groups 2 and 4, starting from the second trimester. In pregnant women with fetal growth retardation in the first trimester, blood pressure variability was higher than in pregnant controls and in the second trimester it was higher than in the group with the subsequent development of preeclempsia. Thus, during pregnancy complicated by preeclempsia or placental insufficiency with fetal growth retardation, high long-term blood pressure variability was observed. At the same time, the highest values were observed in the third trimester.

Conclusion. The assessment of long-term blood pressure variability from the early gestation seems to be an effective tool for detecting preclinical changes in the body of a pregnant woman, preceding the development of preeclempsia and fetal growth retardation, and in the presence of risk factors of preeclampsia allows narrowing the group of patients for target follow-up and prevention.

Abstract

Aim. Assessment of the dental status of patients with mental disorders.

Methods. Examination of 220 mentally ill and 208 practically healthy individuals was carried out using DCF (decay/missing/filled) and CPITN (Community Periodontal Index of Treatment Needs) indices to determine the prevalence and intensity of caries, periodontal disease, and to identify the need for complex dental care. The group were comparable by the age: 35.2±0.39 и 34.3±0.40 years (р=0.115). The functional state of the salivary glands and mouth fluid was studied. Psychoemotional status was determined before starting the treatment by the clinical psychological method using Spielberger-Khanin scale of reactive and personal anxiety levels.

Results. In the study group, the number of patients in whom various forms of caries were detected was 100%, while in the group of mentally healthy subjects the number of such patients was 91.8±1.90% (p=0.001). Due to the high values of intensity of carious disease, especially in terms of the number of teeth extracted, the need of the mentally ill for dentures was recorded to be quite high. The highest intensity of the dental calculi and deep pathological periodontal pockets was found in the study group. Peaks of reduced salivation were more commonly diagnosed in patients with mental illness. Assessing the frequency of occurrence of dentoalveolar anomalies, deep bite and progeny in both groups had the highest ratio relative to other types of anomalies but in the study group, the frequency of cross bite was higher (p=0.015). The rate of reactive anxiety in the course of dental interventions in the study group was 50.1±0.72% versus 31.6±0.57 in the control group (p <0.001). A similar picture was observed when assessing the level of personal anxiety among the subjects.

Conclusion. The research results indicate a high level of incidence of inflammatory-destructive diseases of periodontal tissues and hard dental tissues in the study group of patients with mental disorders; the presence of the studied pathology adversely affects the state of acid-base balance of saliva and the frequency of dento-alveolar anomalies.

Abstract

Aim. To determine the effect of Leu-Ile-Lys tripeptide on indicators of oxidative stress and expression of cyclooxygenase-1 and -2 in the gastric mucosa on the background of experimental indomethacin-induced ulcer.

Methods. Experiments were performed on 35 male Wistar rats with a body mass of 200-250 g aged 2-3 months that were divided into 3 groups: the control group (intact rats, 8 animals), control group (simulation of indomethacin-induced gastropathy, 12 animals) experimental group (simulation of indomethacin-induced gastropathy + administration of Leu-Ile-Lys tripeptide, 15 animals). The tripeptide Leu-Ile-Lys obtained by chemical synthesis (sample purity at least 98%) was administered intragastrically daily for 7 days before the simulation of indomethacin-induced damage of the gastric mucosa in a dose of 11.5 mg/kg. The model of indomethacin-induced damage to the rodent gastric mucosa was reproduced by a single intragastric administration of indomethacin in a dose of 60 mg/kg in 1 ml of saline. In the stomach homogenate the activity of free radical oxidation was determined by conventional methods. For quantitative determination of cyclooxygenase-1, -2 in gastric homogenate the method of enzyme immunoassay was used. The concentration was determined spectrometrically by the color intensity of the samples.

Results. With a prophylactic administration of tripeptide Leu-Ile-Lys, concentration of tiobarbiturate-reactive products was normalized, total antioxidant activity increased and the activity of antioxidant enzymes decreased compared to the control group. The concentration of cyclooxygenase-2 in gastric homogenate from the experimental animals was 2.3 times lower than that of the control rats.

Conclusion. Use of Leu-Ile-Lys tripeptide in experimental indomethacin-induced gastric ulcer showed a significant decrease of oxidative damage and inflammation in the gastric mucosa.

Abstract

Aim. To study the dynamics of inspiratory pressure and volume in two versions of the experiment - mechanical pressure-controlled air-oxygen and helium-oxygen ventilation in the models of «healthy lung», «chronic obstructive pulmonary disease», «acute respiratory distress syndrome».

Methods. Inspiratory pressure and tidal volume were recorded during 10 respiratory cycles at each predetermined level from 5 to 20 cm H2O with a step of 5 cm H2O. TestСhest® was used as a model of the lungs which allows simulating normal function and some pathological states of the lungs sucj as COPD and ARDS.

Conclusion. Pressure-controlled use of helium-oxygen mixture in the simulation of normal breathing mechanics, acute respiratory distress syndrome and chronic obstructive pulmonary disease is accompanied by a statistically significant increase in inspiratory pressure in the airways and inspiratory volume.

Abstract

Currently rheumatoid arthritis is considered as an immune inflammatory disease of unknown origin characterized by chronic erosive arthritis and systemic damage of internal organs, leading to early disability and reduced life expectancy. Cardiovascular diseases are most often mentioned as factors of poor prognosis in rheumatoid arthritis. Pathology of the cardiovascular system in rheumatoid arthritis is usually associated with the macro- and microvascular changes and rheumatoid lesions of the heart. The leading factor in the damage of the vascular wall in rheumatoid arthritis is systemic inflammation affecting its viscosity and elastic properties, increased rigidity, impaired endothelial function. Endothelial dysfunction is currently regarded to as an initial stage of morphogenesis of various vascular disorders. It is considered as a subclinical marker of cardiovascular diseases and the earliest predictor of cardiovascular complications. From this point of view study of endothelial dysfunction in patients with rheumatoid arthritis aimed at determining cardiovascular risk is a perspective direction. Only single and fragmentary information about certain endothelial functions in patients with rheumatoid arthritis and substances released in this. There is no clear analysis of relationship between them and dependence on the process activity. Not clear is their role in the pathology of the vascular wall in rheumatoid arthritis. This literature review discusses the problem of endothelial dysfunction in rheumatoid arthritis patients as well as its role in the development of cardiovascular diseases in these patients. The development mechanisms and the role of immune inflammation in its formation are considered. Also the association was found between chronic inflammatory activity indicators in rheumatoid arthritis and various biological markers and development of endothelial dysfunction. The effects of antirheumatic treatment on endothelial dysfunction in these patients were analyzed.

Abstract

Interest in the issues of antibiotic resistance control and monitoring remains actual during the past decades. A significant number of findings confirm the ever-growing ratio of antimicrobial-resistant microorganisms. The article describes the information resources including data on antimicrobial resistance genes. Efficient monitoring and timely detection of changes in this trend are possible provided that the large volume of information, including the range of the genes characterizing resistance to chemical compounds and medicines, is obtained. Using purpose-built databases describing the nucleotide and amino acid sequences that define antimicrobial resistance is particularly important. Moreover, the databases include data on point mutations in the genome of the microorganisms associated with antimicrobial resistance development. The first developed databases contained the limited information on genetic determinants of resistance. However, modern databases are more than ever tended to a full range display of information on various genes of resistance to antimicrobial medicines and chemical compounds. The approach provides meaningful data supplemented by graphic imaging of results in most cases. Access to a significant part of resources is free of charge and allows saving the final results that considerably simplifies communicating and improves interaction between researchers. A specific feature is continuous information updating and manual curation that provides better systematization of the available data.

Abstract

As a result of road accidents in the Russian Federation, up to 30 thousand people are killed every year, which causes significant demographic and socio-economic damage to the state. The World Health Organization considers road traffic injuries as one of the global problems associated with 1.25 million deaths. In many countries, the leading direction of development of medical care for victims of road traffic accidents is the creation of trauma systems. The main volume of medical care for victims of road traffic accidents and those with severe injuries under other circumstances is provided by trauma centers of the 2nd and 1st levels. The implementation of the federal targeted programs «Improving road safety in 2006-2012» allowed the creation of a network of trauma centers in a number of subjects of the Russian Federation, whose work reduced mortality and disability among victims with severe injuries, but the problem cannot be considered solved because there are no national database of the victims of road accidents (register), system for assessing the severity of injuries and recording long-term results of non-fatal injuries, which excludes the possibility to compare the clinical effectiveness of the Russian trauma centers among themselves and with foreign counterparts.

Abstract

Randomized clinical trials (RCTs) are currently recognized as the gold standard for evaluating the efficacy and safety of medical interventions. However, often the presentation of the results of RCTs in reports and articles does not give a complete and reliable description of all the results of the test, which often leads to incorrect conclusions and guidelines. In order to comply with certain uniform requirements for reporting documents based on materials of the conducted RCT, a group of authors and editors of medical journals in the early 1990s came out with a proposal to the medical community about using common standards for presenting RCT results, which they called CONSORT (CONsolidated Standards Of Reporting). The first version of CONSORT, however, caused a lot of criticism from both authors and editors of journals. The accumulated critical comments were taken into account by the developers of the revised and published in 2010 version of CONSORT, which is currently accepted as a reference for presenting the results of RCT in the world's leading medical journals. CONSORT 2010 contains a statement, supplemented with a set of questions on the conducted RCT, requiring a clearly formalized answer, and a flowchart for visual presentation of the results. In addition, the CONSORT developers submitted a separate document to clarify the terms in order to clarify the cases of application of this methodology. It is important to understand that CONSORT does not include recommendations for developing, conducting and analyzing the trials. It contains only reports on what and how it was done, what was eventually established, and only indirectly affects the design and conduct of RCT. However, authors who are familiar with the requirements of CONSORT will strive to meet these requirements when planning and conducting RCTs. As an example, the article presents a case of assessing the quality of the presentation of one of the RCTs according to CONSORT 2010 standards.

Abstract

Aim. Analysis of the effectiveness of specific preventive measures against tick-borne viral encephalitis among the urban and rural population of the Altai Krai of different age groups in 2000-2017.

Methods. The paper presents the results of a long-term epidemiological analysis of the incidence among urban and rural population of the Altai Krai of tick-borne viral encephalitis in 2000-2017, the calculation of absolute and relative indicators, long-standing dynamics of the incidence of tick-borne viral encephalitis in RF ad Altai Krai was evaluzted as well as summarized parameter of vaccination and revaccination. Statistical data processing was carried out in the program Statistica 12.0.

Results. The study revealed an inverse moderate correlation between the factor of the volume of emergency prophylaxis and the incidence of tick-borne viral encephalitis among the population of the Altai Krai (r=-0.51; p <0.001), between these phenomena in the cohort of adult population of the region (r=-0.50; p <0.001), in the cohort of children in the region (r=-0.52; p <0.001), in the cohort of urban residents (r=-0.54; p <0.001), in the cohort of rural residents (r=-0,45; p <0.001). The causes of differences in the incidence of tick-borne viral encephalitis among the urban and rural population of the Altai Krai were identified, the degree of relation between the average long-term incidence rates and its determining factors were determined, recommendations were developed to optimize the system of preventive measures of tick-borne encephalitis in the region.

Conclusion. The absence of a negative correlation in the various cohorts of the population between the incidence and vaccination levels indicates a lack of effectiveness of vaccination against tick-borne viral encephalitis in the region; at the same time, the inverse moderate correlation revealed between the incidence of tick-borne viral encephalitis and the indicators of emergency immunoprophylaxis indicates a sufficient degree of effectiveness of this specific preventive measure in the Altai Krai.

Abstract

Aim. To study the opinions of specialists in tuberculosis institutions on barriers and ways to improve the system fighting the spread of human immunodeficiency virus (HIV) and tuberculosis.

Methods. In the study questionnaires with open and closed questions were used among employees of tuberculosis facilities in four territories of the North-West Region of Russia (Saint-Petersburg, Leningrad, Arkhangelsk, and Kaliningrad oblasts) during six months in 2018. Total of 284 subjects were included. The questionnaire consisted of 19 structured questions. The respondents’ answers were compared interregionally and were analyzed integrally inside the blocks with the calculation of their ratios.

Results. According to the specialists’ opinion working in tuberculosis facilities, the main barriers to providing tuberculosis services for people living with HIV are low level of intersectoral interaction, migration, increase in the number of injecting drug users, lack of regional government support, inconsistency of regulation documents with the requirements of currant reality. As the main conditions for improvement of epidemic situation with association of HIV/tuberculosis, the respondents consider increasing administration of antiretroviral therapy to the patients with HIV, adequate treatment of tuberculosis in HIV-infection and raising awareness of HIV-infection and tuberculosis by the population.

Conclusion. To improve the existing system of fighting HIV/tuberculosis, strengthening the connection among the stakeholders may be possible, especially between tuberculosis facilities and detention centers giving the valuable access to antiretroviral therapy, chemoprophylaxis and tuberculosis treatment, including establishment of low-threshold centers, improved population awareness of tuberculosis and HIV-infection.

Abstract

Aim. Assessment of the impact of independent ultrasound screening by the emergency physician on the daily activities of the emergency department.

Methods. The effectiveness of the use of ultrasound screening by the emergency physician was assessed using computer-based simulation modeling and the subsequent implementation of the data obtained into the practical work of the emergency department. The results were analyzed using descriptive statistical methods.

Results. In the course of the study, a simulated model of emergency department was built, similar to the actually functioning department in the Pavlov First St. Petersburg State Medical University. The new professional emergency physician’s standard, requiring knowing the basics of ultrasound-based diagnosis, were implemented first in the model and then in everyday practice. Independent ultrasound screening by the emergency physician allows reducing the length of stay of patients in the emergency department and the workload on medical personnel at the same time increasing the capacity of the department which is confirmed both by computer simulation and by actual implementation in the daily activities of the department.

Conclusion. The data received are indicative of a positive impact of independent ultrasound screening on the hospital stay of patients in the department and workload on the medical staff; emergency residency program should be complemented by teaching the basics of ultrasound diagnosis.

Abstract

Clonorchiasis is a disease caused by the parasites of the Chinese fluke (Clonorchis sinensis) characterized by damage of the liver and/or pancreas. The basis of the diagnosis of clonorchiasis is detection of parasite eggs in the feces. Despite this, it may be difficult to confirm this helminthiasis. It should be noted that in case of low-intensity invasions or in the acute period of clonorchiasis, it is not always possible to detect eggs in the feces. The article describes a case of a 38-year-old man admitted to the hospital with a preliminary diagnosis of liver tumor. The diagnosis of clonorchiasis was made after the liver biopsy and identifying of Clonorchis eggs in the duodenal contents. No eggs were found in the feces. The therapy with praziquantel (biltricide) was effective and the patient was discharged in a satisfactory condition.

Abstract

Aim. To present a clinical case of treatment of pigment dispersion syndrome by clear lens extraction and implantation of a toric intraocular lens in a patient with myopic astigmatism.

Methods. A 33-year-old patient with a diagnosis of moderate myopia, complex mild myopic astigmatism, pigment dispersion syndrome of both eyes.

Results. The first stage was laser peripheral iridotomy of both eyes. On follow-up pathological irido-zonular contact and increases intraocular pressure by 2 mm persisted. The second stage included clear lens extraction and implantation of a toric multifocal intraocular lens to both eyes. In 2 months, distance and near visual acuity was 1.0, intraocular pressure was normal, no pathological irido-zonular contact was observed according to the ultrasound biomicroscopy.

Conclusion. Implantation of an intraocular lens in patients with myopia and pigment dispersion syndrome is both a method of preventing pigment glaucoma and myopia correction; patients with pigment dispersion syndrome after peripheral iridotomy should monitor the state of the anterior segment of the eye and the effectiveness of the treatment by ultrasound biomicroscopy.

Abstract

Aim. To evaluate the results of surgical treatment of post-infarction left ventricular aneurysms with on-pump beating heart technique.

Methods. In our center from April, 2009 to January, 2014 169 patients had reconstruction of the left ventricle with on-pump beating heart technique. Among the patients 159 were males (94.1%) and 10 of them were females (5.9%), average age 53.8±8.9 years (39 to 72 years). Angina pectoris class I (according to the classification of Canadian Heart Association) was established in 7 (4.1%) patients, class II - in 49 (29.0%), class III - in 107 (63.3%), class IV - in 4 (2.4%), unstable angina in 2 (1.2%) patients. Chronic heart failure class I (according to New York Heart association functional classification) was diagnosed in 5 (3.0%) patients, class II in 37 (21.9%), class III in 124 (73.4%), class IV in 3 (1.8%) patients. Average ejection fraction of the left ventricle was 38.6±7.9% (25 to 67%). Mitral valve insufficiency stage 2-3 was revealed in 23 (13.6%) patients.

Results. Endoventriculoplasty of the left ventricle by Dor's technique was performed in 49 (29.0%) patients, auto-septoplasty of the left ventricle - 59 (34.9%) patients, linear repair in 40 (23.7%) patients. Combined surgical interventions were performed in 21 (12.4%) patients. In-hospital lethality was 2.4% (n=4).

Conclusion. Left ventricular reconstruction with on-pump beating heart technique without cardioplegic arest is effective and safe; the method allows performing remodelling of the left ventricle and reaching the target volume parameters.

Abstract

Aim. To improve the results of treatment of patients with breast cancer after radical mastectomy through the development and application of a device for wound closure after radical mastectomy, providing favorable conditions for wound healing.

Methods. The proposed device for wound closure after radical mastectomy was used in 42 patients after the mandatory informed consent. A patent for the invention was obtained for the developed device. The study group included patients with indications for performing Madden mastectomy (Halsted, Patey) for breast cancer in the range of stages T1-4N0-1M0. The age of the patients was 57.5±10.4 (m±δ) years. In group 1 (n=21), wound closure after radical mastectomy was performed using the developed device, in group 2 (n=21) - without it.

Results. In the process of working with the developed device, the following positive features were observed. The magnitude of the buckling in the plane of the jaws follows the contour of the thorax in the region of operation of the patient preventing the appearance of the plots of overpressure by the device to the adjacent tissue and ensuring uniformity of traction paravulnar tissues. The complete absence of tissue tension in the area of the suture is the result of the suturing of surgical wounds only after the complete wound edges attachment by means of the device. The above-mentioned factors lead to the formation of point scars in the joints, the absence of extended forms of postoperative scars.

Conclusion. The developed device for wound closure after radical mastectomy performed for breast cancer allows shortening the hospital stay after surgery by 36% (p=0.01) and the deadline for removal of drainage by 31% (p=0.01), reducing the incidence of local necrosis of the flap (p=0.44) compared to traditional suturing of the wounds.

Abstract

Aim. To improve the results of treatment of patients with locally advanced laryngeal cancer by developing organ preservation surgery combined with radiation therapy.

Methods. 20 patients with locally advanced laryngeal cancer stage III (T3N0-1M0) were examined. A surgery was developed that involves lateral resection of the larynx in conjunction with the underlying thyroid cartilage, preserving its upper 1/3-1/4 portion as a horizontal plate not affected by a tumor. On the affected side of the neck, a skin flap is preliminarily harvested, by 1.5-1.0 cm longer and wider than the resulting laryngeal defect. It is put over the fragment of thyroid cartilage left after resection and sutured to the healthy mucosa of the preserved part of the larynx. Laryngostomy and tracheostomy are formed. Tracheostomy tube is inserted. Formed laryngostomy is freely tamponed with two to three tampons with an antiseptic solution for up to 7 days. Naso-esophageal probe is inserted. Patients who did not receive radiation treatment before surgery, receive postoperative gamma-therapy after 14-20 days with cumulative dose up to 40 Gy. Plastic surgery of laryngostomy and tracheostomy is performed after 4-5 months after the intervention.

Results. The developed method of surgery for patients with stage 3 of one half of the larynx allowed a radical removal of the tumor with the restoration of breathing, swallowing and speech. The event-free 5-year survival rate was 80±4.5%, and the total 3-year survival was 100%. Сonclusion. The developed technique of organ-preserving surgery in patients with locally advanced laryngeal cancer stage 3 involving its one half can provide oncological radical technique with the rehabilitation of the functions of the larynx.

Abstract

Aim. Improvement of the efficacy of diagnosis of spondylogenic ethmoiditis in children.

Methods. The study sample included 82 children aged 3 to 10 years: 39 (47.6) boys and 43 (52.4) girls. Patients were divided into three groups. Group 1 included 20 patients with acute ethmoiditis; group 2 included 31 patients with other diseases of ENT-organs; group 3 included 31 relatively healthy children. Apart from physical examination performed by an otorhinolaryngologist, pediatrician, neurologist and other specialists, and X-ray of paranasal sinuses including contrast radiography, the investigation plan included facial electromyography in ethmoid sinus projection area.

Results. Electromyographic parameters in relatively healthy children corresponded to the reference while in patients with acute ethmoiditis muscle tone in ethmoid sinus projection area was increased and amplitude of contractions was decreased, which was caused by muscle spasm. Increased latency of M response was revealed compared to the norm on both sides. In the group of patients with other diseases of ENT organs the following results were obtained: muscle tone in ethmoid sinus projection area was increased as well as in group 2, contraction amplitude was decreased that is a result of spasm and muscle tension. M response latency exceeded normal value only on one side where the most severe inflammatory process was observed.

Conclusion. To confirm the relationship between congenital pathology of the cervical spine and inflammatory process in nasal cavity and cells of ethmoid labyrinth, electromyography is warranted.

Abstract

Aim. To study the capability of applying the method of acoustic analysis of respiration (bronchophonography) in the diagnosis of hyperventilation syndrome and mild bronchial asthma and in differential diagnosis between them.

Methods. 97 subjects were examined (35 men and 62 women, average age 36.4±13.4 years), divided into the groups: control (healthy subjects) - 38 subjects (18 men and 20 women, average age 33.6±14.0 years), patients with mild bronchial asthma - 37 subjects (12 men and 25 women, average age 40.7±13.7 years), patients with hyperventilation syndrome - 22 subjects (5 men and 17 women, average age 35.0±12.6 years). All patients, except for general clinical examination, underwent spirometry, bronchophonography and Nijmegen questionnaire.

Results. Acoustic breathing patterns of all groups were formed, spirometric and bronchophonographic indicators were analyzed. Bronchophonography revealed significant intergroup differences in different frequency ranges in groups of patients with bronchial asthma and hyperventilation syndrome as well as the absence of those between healthy individuals and patients with hyperventilation syndrome. At the same time, the data of spirometry did not allow differentiation of mild bronchial asthma and hyperventilation syndrome and in most cases did not differ from those of healthy individuals.

Conclusion. Spirometry cannot serve as a reliable diagnostic criterion in the diagnosis and differential diagnosis of hyperventilation syndrome and mild bronchial asthma; differences in acoustic indices of respiration in bronchophonography allow such differentiation.

Abstract

Aim. To identify methods for diagnosing early signs of heart failure in patients with chronic obstructive pulmonary disease.

Methods. We examined 54 patients with chronic obstructive pulmonary disease without exacerbation. Patients were divided into two groups: group 1 - 26 patients with chronic obstructive pulmonary disease in combination with chronic heart failure; group 2 - 28 patients with chronic obstructive pulmonary disease without chronic heart failure. The groups were comparable by age and severity of chronic obstructive pulmonary disease. Electrocardiography, echocardiography were performed with additional determination of the right heart chamber parameters, spirometry, X-ray, pulse oximetry. The level of highly sensitive C-reactive protein, blood acid-base composition and brain natriuretic peptide was evaluated.

Results. Patients with comorbidity have decreased exercise tolerance according to the 6-minute walk test and mMRS scale, higher body mass index and dyspnea intensity, larger linear dimensions of the heart chambers and their volume parameters. Heart failure with preserved ejection fraction was observed in 21 (80%) of patients in group 1, therefore, the signs of heart failure can be explained by diastolic dysfunction of the right and left ventricles. Among patients with chronic obstructive pulmonary disease and chronic heart failure in our study, extended linear dimensions and structural changes in the ventricles, indicating pre- and postcapillary hypertension, were significantly more common.

Conclusion. The use of tissue Doppler study allows more accurately determining the diastolic function of the right and left ventricles; the brain natriuretic peptide study is a sensitive marker of early forms of diastolic chronic heart failure.

Abstract

The review describes perioperative complications of laparoscopic cholecystectomy. Over the past 30 years, laparoscopy has become the «gold standard» for cholecystectomy and one of the most frequently performed procedures in abdominal surgery. Nevertheless, despite the advantages of the method, it has an «Achilles heel» - the frequency of iatrogenic damage to the extrahepatic bile ducts is 3-5 times higher than with an open cholecystectomy. This complication has a negative effect on the survival of patients after surgery, leads to deterioration in the quality of life and is a major source of legal costs in many countries. In general, the total range for any damage to the biliary tract during laparoscopic cholecystectomy is 0.32-0.52%, while the complication rate and mortality rate are 1.6-5.3% and 0.08-0.14%, respectively. Patients who have undergone a complete intersection of the hepaticoholedochus, become «bile cripples» for life. Recurrent cholangitis, strictures of anastomoses with a possible outcome in liver cirrhosis are quite likely in later periods after damage to the intrahepatic bile ducts. Technological efforts to improve the results of laparoscopic cholecystectomy reside. These include the routine use of intraoperative cholangiography, infrared fluorescent cholangiography, etc. Nevertheless, despite the growing number of methods designed to reduce these complications, evidence of their effectiveness remains limited. The most important factors ensuring the safety of laparoscopic cholecystectomy are recognized: understanding of anatomy, adequate exposure when using electrosurgery, psychological readiness to invite a senior colleague in time for help, the ability to recognize a situation that requires conversion and rejection of laparoscopy.